Provider Demographics
NPI:1962446161
Name:BEACHAM, RICHARD GRADY (MS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GRADY
Last Name:BEACHAM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3202
Mailing Address - Country:US
Mailing Address - Phone:910-799-1071
Mailing Address - Fax:910-799-3313
Practice Address - Street 1:2734 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7511
Practice Address - Country:US
Practice Address - Phone:910-799-1071
Practice Address - Fax:910-799-3313
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9557101YP2500X
MDLC2988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional